NEWS AND FACTS ABOUT MEDICINES YOU TAKE

Ritalin Shares Same Abuse Potential as Amphetamines according to the U.S. Dept. of Justice

“Of particular concern is that ADHD literature prepared for public consumption does not address the potential or actual abuse of methylphenidate. Instead, methylphenidate is routinely portrayed as a benign, mild substance that is not associated with abuse or serious side effects. In reality, however, the scientific literature indicates that methylphenidate [Ritalin] shares the same abuse potential as other Schedule II stimulants. Further, case reports document that methylphenidate abuse can lead to tolerance and severe psychological dependence.”

Ritalin Side Effects and Warnings

Ritalin (methylphenidate) is an amphetamine-like prescription stimulant commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adults.

Many think Ritalin is safe, or mild, because so many children use it. However, the government classifies the psychoactive drug with cocaine and morphine because it's highly addictive.

FDA: “Black Box” Warning

The Food and Drug Administration (FDA) requires the following “black box” warning on all methylphenidate drugs, including Ritalin, which means that medical studies indicate Ritalin carries a significant risk of serious, or even life-threatening, adverse effects.

WARNING

RITALIN-SR IS A FEDERALLY CONTROLLED SUBSTANCE (CII) BECAUSE IT CAN BE ABUSED OR LEAD TO DEPENDENCE. KEEP RITALIN-SR IN A SAFE PLACE TO PREVENT MISUSE AND ABUSE. SELLING OR GIVING AWAY RITALIN-SR MAY HARM OTHERS, AND IS AGAINST THE LAW.

TELL YOUR DOCTOR IF YOU OR YOUR CHILD HAVE (OR HAVE A FAMILY HISTORY OF) EVER ABUSED OR BEEN DEPENDENT ON ALCOHOL, PRESCRIPTION MEDICINES OR STREET DRUGS.

ABOVE: FDA black box warning label appears on the manufacturer's wholesale packaging and is the strongest alert the FDA can require.

Used For

Attention deficit disorder

Narcolepsy

How Does Ritalin Work?

Ritalin works by initiating the acute stress response (“fight or flight” response). The central nervous system prepares the body for physical action by creating physiological changes as if it were stressed or under threat. These changes include:

The release of adrenalin, raises cortisol levels and other stress hormones

Increased heart rate and blood pressure

Redirected blood flow into the muscles and away from the brain

Methylphenidate (Ritalin) was first synthesized in 1944 in an (unsuccessful) attempt to create a stimulant that would not induce addiction or tolerance. Ritalin is very closely related to amphetamine— similar in chemical structure, metabolization and clinical effects. This close connection is the chief reason Ritalin use raises concern among patients and others.

Do Not Use If

You have high blood pressure or any form of heart disease, are very nervous or have severe insomnia, have a history of addiction to drugs or alcohol. Do not combine with monoamine oxidase inhibitors.

FDA: Links Between ADHD Drugs and Priapism and Sexual Dysfunction

In a 2013 drug-safety announcement, the FDA announced that drugs containing methylphenidate (Ritalin, Concerta, Daytrana, Focalin, Metadate, Methylin, Quillivant) must including warnings about the risk of priapism. It's a serious problem. Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

The FDA included an even stronger warning about atomoxetine (Strattera): “Priapism appears to be more common in patients taking atomoxetine than in patients taking methylphenidate products. Health care professionals should be cautious when considering changing patients from methylphenidate to atomoxetine (Strattera).”

The safety warning also raised concerns about links between priapism and amphetamine drugs, which include Adderall, Dexedrine, ProCentra and Vyvanse.

Overdose Side Effects

Ritalin has been extensively abused. Extreme psychological dependence and severe social disability have resulted. Abuse of Ritalin may cause a sudden heart attack—even in those with no signs of heart disease. Symptoms of overdose that require immediate medical assistance include:

Restlessness

Tremor

Aggression

Hallucinations

Panic states

Hyperreflexia (overactive reflexes, which can include twitching or spasms)

Personality changes

Symptoms of depression

Seizures or abnormal EEGs

High blood pressure

Rapid heart beat

Swelling of hands/feet/ankles (for example, numbing of the fingertips)

Delusions

Sweating

Vomiting

Dehydration

Unexplained muscle pain

Lower abdominal pain

Rhabdomyolysis and kidney damage

Chronic abuse can manifest itself as psychosis, often indistinguishable from schizophrenia

“Physiological effects of oral cocaine and methylphenidate (Ritalin) were similar.”

What to Do About Side Effects

The last dose of the drug every day should be taken several hours before bedtime to prevent insomnia.

Nervousness usually goes away and appetite often returns so that weight loss is rarely dangerous.

If high blood pressure, rapid pulse, paranoia, or tolerance becomes a problem, the drug is usually stopped.

Nothing can be done about the addiction except to remember not to stop taking any type of methylphenidate abruptly.

Abrupt cessation of stimulant drugs such as Ritalin can cause extreme fatigue and severe, even suicidal, depression in adult patients.

ABOVE: The Essential Guide to Psychiatric Drugs—Rev. and updated (2007).

Dependence, Tolerance and Withdrawal

It is possible to build up a tolerance to methylphenidate, which means the person using the drug needs to take larger doses to achieve the same effect. Over time, the body might come to depend on methylphenidate drugs just to function normally. The person craves the drug and their psychological dependence makes them panic if access is denied, even temporarily.

Withdrawal symptoms can include tiredness, panic attacks, crankiness, extreme hunger, depression and nightmares. Some people experience a pattern of “binge crash” characterized by using continuously for several days without sleep, followed by a period of heavy sleeping.

If It Doesn't Work

The drug should be stopped gradually. Withdrawal symptoms are psychological and stopping suddenly can cause extreme fatigue and severe, even suicidal, depression in adult patients.

If It Does Work

“Also, in addition to increasing heart rate and blood pressure, causing insomnia and weight loss, and sometimes causing psychotic symptoms, the stimulant medications used for ADHD (methylphenidate and amphetamines) may cause heart disease if taken for a long time. The latter problem led to a debate within the FDA, well covered by newspapers, about whether to issue a special warning to doctors. In the end, the FDA decided not to do this, but the risk remains,” reports Jack M. Gorman, M.D., professor of psychiatry at Columbia University and deputy director of the New York State Psychiatric Institute. Ritalin “is a very powerful drug that undoubtedly works for ADHD, but there are alternatives with less abuse potential that should be tried first.”

NY Times: Children's A.D.D. Drugs Don't Work Long-Term

The NY Times, in an op-ed article by L. Alan Sroufe, a professor emeritus of psychology at the University of Minnesota's Institute of Child Development, stated the following:

“Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects... Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children's bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.”

Long-Term Effects of Ritalin—Changes in Brain Development

The same damage as in Alzheimer's.

Ongoing research shows early-life use of Ritalin (methylphenidate) has complex effects that endure later into life. A study published in Biological Psychiatry suggests that exposure of Ritalin in youth may later disrupt development of brain cells in the hippocampus, region of the brain critical to memory, spatial navigation, and behavioral inhibition and resulting in memory problems, disorientation and depression in adulthood.

Damage caused by Ritalin is the same as seen in Alzheimer's disease where the hippocampus is one of the first areas of the brain to suffer damage so memory problems and disorientation appear among the first symptoms.

What is the most important information I should know about RITALIN-SR?

The following have been reported with use of RITALIN-SR and other stimulant medicines.

1. Heart-related problems:

sudden death in patients who have heart problems or heart defects

stroke and heart attack in adults

increased blood pressure and heart rate

Tell your doctor if you or your child have any heart problems, heart defects, high
blood pressure, or a family history of these problems.
Your doctor should check you or your child carefully for heart problems before
starting RITALIN-SR.

Your doctor should check you or your child's blood pressure and heart rate
regularly during treatment with RITALIN-SR.

Call your doctor right away if you or your child has any signs of heart
problems such as chest pain, shortness of breath, or fainting while
taking RITALIN-SR.

2. Mental (Psychiatric) problems:

All Patients

new or worse behavior and thought problems

new or worse bipolar illness

new or worse aggressive behavior or hostility

Children and Teenagers

new psychotic symptoms (such as hearing voices, believing things that
are not true, are suspicious) or new manic symptoms

Tell your doctor about any mental problems you or your child have, or about a
family history of suicide, bipolar illness, or depression.

Call your doctor right away if you or your child have any new or
worsening mental symptoms or problems while taking RITALIN-SR, especially seeing or hearing things that are not real, believing things that
are not real, or are suspicious.

ABOVE: Ritalin-SR Medication Guide, rev. 4/2007.

“Ritalin and amphetamine both produce gross reductions in blood flow to the brain”.

Decreased blood flow to the brain plays a major role in cognitive impairment, dementia and Alzheimer's.

LEGAL DISCLAIMER: This website is for general information purposes only. Statements and excerpts from research literature are provided solely as a forum for commentary and specifically not as health or medical advice. Only your physician should diagnose your health problem and prescribe treatment. DO NOT CHANGE OR STOP TAKING MEDICATION BASED ON INFORMATION YOU READ AT THIS WEBSITE. If you have a question about a drug, or if you think you are experiencing a drug's side effect, consult with your doctor.